WCC 2014

MELBOURNE – Widespread availability of automated external defibrillators is far more likely than screening to prevent sudden cardiac deaths on the sports field, and has the added benefit of also preventing deaths off the sports field, said Dr. N.A. Mark Estes, professor of medicine at Tufts University, Boston.

He said there were significant knowledge gaps around the sensitivity, specificity, and predictive accuracy of screening for sudden cardiac death in athletes, and existing screening guidelines were the subject of great criticism.

"Each one of these deaths is tragic, and everyone understandably reacts in a fashion where they want to do something to prevent it," Dr. Estes, also director of the cardiac arrhythmia center at Tufts, said at the World Congress of Cardiology.

Bianca Nogrady/Frontline Medical News

"The notion has arisen that in Italy they have an effective screening program that can identify athletes at risk of sudden cardiac death, so we should be able to do it in the United States."

There are, however, significant differences between Italy and the United States, which made it unlikely that the success of the Italian screening efforts could be replicated here, he said.

"The Italians have specialized centers that are regional, they have highly skilled physicians, they have a demographic that’s completely different with a very homogeneous population base and a condition called ARVC [arrhythmogenic right ventricular cardiomyopathy] that you can effectively screen for with ECG and echocardiography."

Guidelines from the American College of Cardiology/American Heart Association currently recommend a 2-4 yearly history and physical examination for young athletes but, unlike Italy, they do not include an ECG.

The other challenge with screening is that, despite the extensive media coverage given to athletes’ deaths on the field, the condition is very rare, claiming around 150 lives each year on the sports field and 4,000 deaths off of it.

Dr. Estes said screening might result in significant numbers of athletes being excluded from the sports field even though we don’t know if restricting athletes from sport does in fact have an impact.

Instead, he argued in favor of greater availability of automated external defibrillators (AEDs) in public places and particularly recreation sites, with evidence showing survival rates above 75% for sudden cardiac death in participating high schools and colleges.

"We need to recognize that the effectiveness of the AED on the athletic field is extremely high, and we do have a way of preventing sudden death even though we can’t predict it, and the benefits for society go well beyond the athletic field," Dr. Estes said in an interview.

"If you look at the evidence, it tells us that screening hasn’t worked in the United States; it is epidemiologically and statistically highly improbable that it would ever work; so let’s put our money into something that’s going to have some proven benefits in a cost-effective fashion."

Commenting on the presentation, Dr. David Prior of St. Vincent’s Hospital, Melbourne, said he was supportive of the idea of secondary rather than primary prevention of sudden cardiac arrest.

"There is certainly ongoing debate, and there are no really good randomized, controlled trials comparing screening to no screening, and I don’t think anyone is either brave enough or has pockets deep enough, because it would be a huge trial because the event rate is so low," Dr. Prior said at the meeting, which was sponsored by the World Heart Federation.

Dr. Prior said screening was a fairly blunt tool, whereas the data suggested that AEDs were effective.

Dr. Estes disclosed consultancies with Medtronic, Boston Scientific, and St. Jude Medical.

MELBOURNE – Widespread availability of automated external defibrillators is far more likely than screening to prevent sudden cardiac deaths on the sports field, and has the added benefit of also preventing deaths off the sports field, said Dr. N.A. Mark Estes, professor of medicine at Tufts University, Boston.

He said there were significant knowledge gaps around the sensitivity, specificity, and predictive accuracy of screening for sudden cardiac death in athletes, and existing screening guidelines were the subject of great criticism.

"Each one of these deaths is tragic, and everyone understandably reacts in a fashion where they want to do something to prevent it," Dr. Estes, also director of the cardiac arrhythmia center at Tufts, said at the World Congress of Cardiology.

Bianca Nogrady/Frontline Medical News

"The notion has arisen that in Italy they have an effective screening program that can identify athletes at risk of sudden cardiac death, so we should be able to do it in the United States."

There are, however, significant differences between Italy and the United States, which made it unlikely that the success of the Italian screening efforts could be replicated here, he said.

"The Italians have specialized centers that are regional, they have highly skilled physicians, they have a demographic that’s completely different with a very homogeneous population base and a condition called ARVC [arrhythmogenic right ventricular cardiomyopathy] that you can effectively screen for with ECG and echocardiography."

Guidelines from the American College of Cardiology/American Heart Association currently recommend a 2-4 yearly history and physical examination for young athletes but, unlike Italy, they do not include an ECG.

The other challenge with screening is that, despite the extensive media coverage given to athletes’ deaths on the field, the condition is very rare, claiming around 150 lives each year on the sports field and 4,000 deaths off of it.

Dr. Estes said screening might result in significant numbers of athletes being excluded from the sports field even though we don’t know if restricting athletes from sport does in fact have an impact.

Instead, he argued in favor of greater availability of automated external defibrillators (AEDs) in public places and particularly recreation sites, with evidence showing survival rates above 75% for sudden cardiac death in participating high schools and colleges.

"We need to recognize that the effectiveness of the AED on the athletic field is extremely high, and we do have a way of preventing sudden death even though we can’t predict it, and the benefits for society go well beyond the athletic field," Dr. Estes said in an interview.

"If you look at the evidence, it tells us that screening hasn’t worked in the United States; it is epidemiologically and statistically highly improbable that it would ever work; so let’s put our money into something that’s going to have some proven benefits in a cost-effective fashion."

Commenting on the presentation, Dr. David Prior of St. Vincent’s Hospital, Melbourne, said he was supportive of the idea of secondary rather than primary prevention of sudden cardiac arrest.

"There is certainly ongoing debate, and there are no really good randomized, controlled trials comparing screening to no screening, and I don’t think anyone is either brave enough or has pockets deep enough, because it would be a huge trial because the event rate is so low," Dr. Prior said at the meeting, which was sponsored by the World Heart Federation.

Dr. Prior said screening was a fairly blunt tool, whereas the data suggested that AEDs were effective.

Dr. Estes disclosed consultancies with Medtronic, Boston Scientific, and St. Jude Medical.

MELBOURNE – Widespread availability of automated external defibrillators is far more likely than screening to prevent sudden cardiac deaths on the sports field, and has the added benefit of also preventing deaths off the sports field, said Dr. N.A. Mark Estes, professor of medicine at Tufts University, Boston.

He said there were significant knowledge gaps around the sensitivity, specificity, and predictive accuracy of screening for sudden cardiac death in athletes, and existing screening guidelines were the subject of great criticism.

"Each one of these deaths is tragic, and everyone understandably reacts in a fashion where they want to do something to prevent it," Dr. Estes, also director of the cardiac arrhythmia center at Tufts, said at the World Congress of Cardiology.

Bianca Nogrady/Frontline Medical News

"The notion has arisen that in Italy they have an effective screening program that can identify athletes at risk of sudden cardiac death, so we should be able to do it in the United States."

There are, however, significant differences between Italy and the United States, which made it unlikely that the success of the Italian screening efforts could be replicated here, he said.

"The Italians have specialized centers that are regional, they have highly skilled physicians, they have a demographic that’s completely different with a very homogeneous population base and a condition called ARVC [arrhythmogenic right ventricular cardiomyopathy] that you can effectively screen for with ECG and echocardiography."

Guidelines from the American College of Cardiology/American Heart Association currently recommend a 2-4 yearly history and physical examination for young athletes but, unlike Italy, they do not include an ECG.

The other challenge with screening is that, despite the extensive media coverage given to athletes’ deaths on the field, the condition is very rare, claiming around 150 lives each year on the sports field and 4,000 deaths off of it.

Dr. Estes said screening might result in significant numbers of athletes being excluded from the sports field even though we don’t know if restricting athletes from sport does in fact have an impact.

Instead, he argued in favor of greater availability of automated external defibrillators (AEDs) in public places and particularly recreation sites, with evidence showing survival rates above 75% for sudden cardiac death in participating high schools and colleges.

"We need to recognize that the effectiveness of the AED on the athletic field is extremely high, and we do have a way of preventing sudden death even though we can’t predict it, and the benefits for society go well beyond the athletic field," Dr. Estes said in an interview.

"If you look at the evidence, it tells us that screening hasn’t worked in the United States; it is epidemiologically and statistically highly improbable that it would ever work; so let’s put our money into something that’s going to have some proven benefits in a cost-effective fashion."

Commenting on the presentation, Dr. David Prior of St. Vincent’s Hospital, Melbourne, said he was supportive of the idea of secondary rather than primary prevention of sudden cardiac arrest.

"There is certainly ongoing debate, and there are no really good randomized, controlled trials comparing screening to no screening, and I don’t think anyone is either brave enough or has pockets deep enough, because it would be a huge trial because the event rate is so low," Dr. Prior said at the meeting, which was sponsored by the World Heart Federation.

Dr. Prior said screening was a fairly blunt tool, whereas the data suggested that AEDs were effective.

Dr. Estes disclosed consultancies with Medtronic, Boston Scientific, and St. Jude Medical.

MELBOURNE – Elevated total cholesterol and low-density lipoprotein cholesterol levels in patients with coronary heart disease were significantly associated with an increased risk of chronic kidney disease, according to a retrospective analysis of data from two large, randomized, controlled trials.

Data presented at the World Congress of Cardiology 2014 showed total cholesterol levels above 240 mg/dL were associated with a significant 78% increase in the risk of chronic kidney disease, while LDL cholesterol greater than 190 mg/dL was associated with a 72% increase in risk.

Elevated non–high-density lipoprotein cholesterol levels and the ratio of total cholesterol to HDL cholesterol were both associated with elevated risk of chronic kidney disease, but reduced HDL cholesterol and the ratio of apolipoprotein B/apolipoprotein A did not significantly affect risk.

Dyslipidemia is present in around 60% of patients with chronic kidney disease, noted presenter Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco. Previous studies in patients with coronary heart disease and chronic kidney disease also have shown that statins have a renoprotective effect.

However, Dr. Deedwania said there has been little exploration of the impact of baseline lipid parameters on renal function.

"We have found that there is a significant increase in not only the prevalence but also the morbidity and mortality in people with chronic kidney disease with coronary events and other cardiovascular events," Dr. Deedwania said in an interview.

Using data from the Treating to New Targets (TNT) study and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study, in which patients were treated with either atorvastatin or simvastatin, researchers were able to examine the relationship between baseline lipoprotein parameters and kidney function in a combined cohort of more than 19,000 patients with coronary heart disease.

"That showed very good relationship between total cholesterol and LDL cholesterol with progressive decline in renal function, which then helped me explain what I had observed earlier in terms of improvement in kidney function in early-stage patients with statins," Dr. Deedwania said at the meeting, which was sponsored by the World Heart Federation.

The relationship between lipoprotein parameters and chronic kidney disease persisted even after adjustment for age, body mass index, smoking status, diabetes history and status, hypertension, and treatment assignment.

The study defined chronic kidney disease as an estimated glomerular filtration rate below 60 mL/min per 1.73 m². However, Dr. Deedwania said no patients achieved stage 4 kidney disease, and all eGFR measurements fell between 45 and 60 mL/min per 1.73 m².

The analysis used a relatively early definition of kidney disease as the outcome of interest, observed session chair Dr. Vlado Perkovic, professor of medicine at the University of Sydney (Australia).

Dr. Deedwania later said he believed the key was to focus on early-stage interventions rather than waiting until the disease progressed and suggested some interventional trials had failed to achieve an effect because they were done in more advanced patients.

The researchers declared a range of speakers fees, consultancies, and honoraria from the pharmaceutical industry; two of the authors were employees of Pfizer.

MELBOURNE – Elevated total cholesterol and low-density lipoprotein cholesterol levels in patients with coronary heart disease were significantly associated with an increased risk of chronic kidney disease, according to a retrospective analysis of data from two large, randomized, controlled trials.

Data presented at the World Congress of Cardiology 2014 showed total cholesterol levels above 240 mg/dL were associated with a significant 78% increase in the risk of chronic kidney disease, while LDL cholesterol greater than 190 mg/dL was associated with a 72% increase in risk.

Elevated non–high-density lipoprotein cholesterol levels and the ratio of total cholesterol to HDL cholesterol were both associated with elevated risk of chronic kidney disease, but reduced HDL cholesterol and the ratio of apolipoprotein B/apolipoprotein A did not significantly affect risk.

Dyslipidemia is present in around 60% of patients with chronic kidney disease, noted presenter Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco. Previous studies in patients with coronary heart disease and chronic kidney disease also have shown that statins have a renoprotective effect.

However, Dr. Deedwania said there has been little exploration of the impact of baseline lipid parameters on renal function.

"We have found that there is a significant increase in not only the prevalence but also the morbidity and mortality in people with chronic kidney disease with coronary events and other cardiovascular events," Dr. Deedwania said in an interview.

Using data from the Treating to New Targets (TNT) study and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study, in which patients were treated with either atorvastatin or simvastatin, researchers were able to examine the relationship between baseline lipoprotein parameters and kidney function in a combined cohort of more than 19,000 patients with coronary heart disease.

"That showed very good relationship between total cholesterol and LDL cholesterol with progressive decline in renal function, which then helped me explain what I had observed earlier in terms of improvement in kidney function in early-stage patients with statins," Dr. Deedwania said at the meeting, which was sponsored by the World Heart Federation.

The relationship between lipoprotein parameters and chronic kidney disease persisted even after adjustment for age, body mass index, smoking status, diabetes history and status, hypertension, and treatment assignment.

The study defined chronic kidney disease as an estimated glomerular filtration rate below 60 mL/min per 1.73 m². However, Dr. Deedwania said no patients achieved stage 4 kidney disease, and all eGFR measurements fell between 45 and 60 mL/min per 1.73 m².

The analysis used a relatively early definition of kidney disease as the outcome of interest, observed session chair Dr. Vlado Perkovic, professor of medicine at the University of Sydney (Australia).

Dr. Deedwania later said he believed the key was to focus on early-stage interventions rather than waiting until the disease progressed and suggested some interventional trials had failed to achieve an effect because they were done in more advanced patients.

The researchers declared a range of speakers fees, consultancies, and honoraria from the pharmaceutical industry; two of the authors were employees of Pfizer.

MELBOURNE – Elevated total cholesterol and low-density lipoprotein cholesterol levels in patients with coronary heart disease were significantly associated with an increased risk of chronic kidney disease, according to a retrospective analysis of data from two large, randomized, controlled trials.

Data presented at the World Congress of Cardiology 2014 showed total cholesterol levels above 240 mg/dL were associated with a significant 78% increase in the risk of chronic kidney disease, while LDL cholesterol greater than 190 mg/dL was associated with a 72% increase in risk.

Elevated non–high-density lipoprotein cholesterol levels and the ratio of total cholesterol to HDL cholesterol were both associated with elevated risk of chronic kidney disease, but reduced HDL cholesterol and the ratio of apolipoprotein B/apolipoprotein A did not significantly affect risk.

Dyslipidemia is present in around 60% of patients with chronic kidney disease, noted presenter Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco. Previous studies in patients with coronary heart disease and chronic kidney disease also have shown that statins have a renoprotective effect.

However, Dr. Deedwania said there has been little exploration of the impact of baseline lipid parameters on renal function.

"We have found that there is a significant increase in not only the prevalence but also the morbidity and mortality in people with chronic kidney disease with coronary events and other cardiovascular events," Dr. Deedwania said in an interview.

Using data from the Treating to New Targets (TNT) study and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study, in which patients were treated with either atorvastatin or simvastatin, researchers were able to examine the relationship between baseline lipoprotein parameters and kidney function in a combined cohort of more than 19,000 patients with coronary heart disease.

"That showed very good relationship between total cholesterol and LDL cholesterol with progressive decline in renal function, which then helped me explain what I had observed earlier in terms of improvement in kidney function in early-stage patients with statins," Dr. Deedwania said at the meeting, which was sponsored by the World Heart Federation.

The relationship between lipoprotein parameters and chronic kidney disease persisted even after adjustment for age, body mass index, smoking status, diabetes history and status, hypertension, and treatment assignment.

The study defined chronic kidney disease as an estimated glomerular filtration rate below 60 mL/min per 1.73 m². However, Dr. Deedwania said no patients achieved stage 4 kidney disease, and all eGFR measurements fell between 45 and 60 mL/min per 1.73 m².

The analysis used a relatively early definition of kidney disease as the outcome of interest, observed session chair Dr. Vlado Perkovic, professor of medicine at the University of Sydney (Australia).

Dr. Deedwania later said he believed the key was to focus on early-stage interventions rather than waiting until the disease progressed and suggested some interventional trials had failed to achieve an effect because they were done in more advanced patients.

The researchers declared a range of speakers fees, consultancies, and honoraria from the pharmaceutical industry; two of the authors were employees of Pfizer.

MELBOURNE – Elevated total cholesterol and low-density lipoprotein cholesterol levels in patients with coronary heart disease were significantly associated with an increased risk of chronic kidney disease, according to a retrospective analysis of data from two large, randomized, controlled trials.

Data presented at the World Congress of Cardiology 2014 showed total cholesterol levels above 240 mg/dL were associated with a significant 78% increase in the risk of chronic kidney disease, while LDL cholesterol greater than 190 mg/dL was associated with a 72% increase in risk.

Elevated non–high-density lipoprotein cholesterol levels and the ratio of total cholesterol to HDL cholesterol were both associated with elevated risk of chronic kidney disease, but reduced HDL cholesterol and the ratio of apolipoprotein B/apolipoprotein A did not significantly affect risk.

Dyslipidemia is present in around 60% of patients with chronic kidney disease, noted presenter Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco. Previous studies in patients with coronary heart disease and chronic kidney disease also have shown that statins have a renoprotective effect.

However, Dr. Deedwania said there has been little exploration of the impact of baseline lipid parameters on renal function.

"We have found that there is a significant increase in not only the prevalence but also the morbidity and mortality in people with chronic kidney disease with coronary events and other cardiovascular events," Dr. Deedwania said in an interview.

Using data from the Treating to New Targets (TNT) study and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study, in which patients were treated with either atorvastatin or simvastatin, researchers were able to examine the relationship between baseline lipoprotein parameters and kidney function in a combined cohort of more than 19,000 patients with coronary heart disease.

"That showed very good relationship between total cholesterol and LDL cholesterol with progressive decline in renal function, which then helped me explain what I had observed earlier in terms of improvement in kidney function in early-stage patients with statins," Dr. Deedwania said at the meeting, which was sponsored by the World Heart Federation.

The relationship between lipoprotein parameters and chronic kidney disease persisted even after adjustment for age, body mass index, smoking status, diabetes history and status, hypertension, and treatment assignment.

The study defined chronic kidney disease as an estimated glomerular filtration rate below 60 mL/min per 1.73 m². However, Dr. Deedwania said no patients achieved stage 4 kidney disease, and all eGFR measurements fell between 45 and 60 mL/min per 1.73 m².

The analysis used a relatively early definition of kidney disease as the outcome of interest, observed session chair Dr. Vlado Perkovic, professor of medicine at the University of Sydney (Australia).

Dr. Deedwania later said he believed the key was to focus on early-stage interventions rather than waiting until the disease progressed and suggested some interventional trials had failed to achieve an effect because they were done in more advanced patients.

The researchers declared a range of speakers fees, consultancies, and honoraria from the pharmaceutical industry; two of the authors were employees of Pfizer.

MELBOURNE – Elevated total cholesterol and low-density lipoprotein cholesterol levels in patients with coronary heart disease were significantly associated with an increased risk of chronic kidney disease, according to a retrospective analysis of data from two large, randomized, controlled trials.

Data presented at the World Congress of Cardiology 2014 showed total cholesterol levels above 240 mg/dL were associated with a significant 78% increase in the risk of chronic kidney disease, while LDL cholesterol greater than 190 mg/dL was associated with a 72% increase in risk.

Elevated non–high-density lipoprotein cholesterol levels and the ratio of total cholesterol to HDL cholesterol were both associated with elevated risk of chronic kidney disease, but reduced HDL cholesterol and the ratio of apolipoprotein B/apolipoprotein A did not significantly affect risk.

Dyslipidemia is present in around 60% of patients with chronic kidney disease, noted presenter Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco. Previous studies in patients with coronary heart disease and chronic kidney disease also have shown that statins have a renoprotective effect.

However, Dr. Deedwania said there has been little exploration of the impact of baseline lipid parameters on renal function.

"We have found that there is a significant increase in not only the prevalence but also the morbidity and mortality in people with chronic kidney disease with coronary events and other cardiovascular events," Dr. Deedwania said in an interview.

Using data from the Treating to New Targets (TNT) study and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study, in which patients were treated with either atorvastatin or simvastatin, researchers were able to examine the relationship between baseline lipoprotein parameters and kidney function in a combined cohort of more than 19,000 patients with coronary heart disease.

"That showed very good relationship between total cholesterol and LDL cholesterol with progressive decline in renal function, which then helped me explain what I had observed earlier in terms of improvement in kidney function in early-stage patients with statins," Dr. Deedwania said at the meeting, which was sponsored by the World Heart Federation.

The relationship between lipoprotein parameters and chronic kidney disease persisted even after adjustment for age, body mass index, smoking status, diabetes history and status, hypertension, and treatment assignment.

The study defined chronic kidney disease as an estimated glomerular filtration rate below 60 mL/min per 1.73 m². However, Dr. Deedwania said no patients achieved stage 4 kidney disease, and all eGFR measurements fell between 45 and 60 mL/min per 1.73 m².

The analysis used a relatively early definition of kidney disease as the outcome of interest, observed session chair Dr. Vlado Perkovic, professor of medicine at the University of Sydney (Australia).

Dr. Deedwania later said he believed the key was to focus on early-stage interventions rather than waiting until the disease progressed and suggested some interventional trials had failed to achieve an effect because they were done in more advanced patients.

The researchers declared a range of speakers fees, consultancies, and honoraria from the pharmaceutical industry; two of the authors were employees of Pfizer.

MELBOURNE – Elevated total cholesterol and low-density lipoprotein cholesterol levels in patients with coronary heart disease were significantly associated with an increased risk of chronic kidney disease, according to a retrospective analysis of data from two large, randomized, controlled trials.

Data presented at the World Congress of Cardiology 2014 showed total cholesterol levels above 240 mg/dL were associated with a significant 78% increase in the risk of chronic kidney disease, while LDL cholesterol greater than 190 mg/dL was associated with a 72% increase in risk.

Elevated non–high-density lipoprotein cholesterol levels and the ratio of total cholesterol to HDL cholesterol were both associated with elevated risk of chronic kidney disease, but reduced HDL cholesterol and the ratio of apolipoprotein B/apolipoprotein A did not significantly affect risk.

Dyslipidemia is present in around 60% of patients with chronic kidney disease, noted presenter Dr. Prakash Deedwania, professor of medicine at the University of California, San Francisco. Previous studies in patients with coronary heart disease and chronic kidney disease also have shown that statins have a renoprotective effect.

However, Dr. Deedwania said there has been little exploration of the impact of baseline lipid parameters on renal function.

"We have found that there is a significant increase in not only the prevalence but also the morbidity and mortality in people with chronic kidney disease with coronary events and other cardiovascular events," Dr. Deedwania said in an interview.

Using data from the Treating to New Targets (TNT) study and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study, in which patients were treated with either atorvastatin or simvastatin, researchers were able to examine the relationship between baseline lipoprotein parameters and kidney function in a combined cohort of more than 19,000 patients with coronary heart disease.

"That showed very good relationship between total cholesterol and LDL cholesterol with progressive decline in renal function, which then helped me explain what I had observed earlier in terms of improvement in kidney function in early-stage patients with statins," Dr. Deedwania said at the meeting, which was sponsored by the World Heart Federation.

The relationship between lipoprotein parameters and chronic kidney disease persisted even after adjustment for age, body mass index, smoking status, diabetes history and status, hypertension, and treatment assignment.

The study defined chronic kidney disease as an estimated glomerular filtration rate below 60 mL/min per 1.73 m². However, Dr. Deedwania said no patients achieved stage 4 kidney disease, and all eGFR measurements fell between 45 and 60 mL/min per 1.73 m².

The analysis used a relatively early definition of kidney disease as the outcome of interest, observed session chair Dr. Vlado Perkovic, professor of medicine at the University of Sydney (Australia).

Dr. Deedwania later said he believed the key was to focus on early-stage interventions rather than waiting until the disease progressed and suggested some interventional trials had failed to achieve an effect because they were done in more advanced patients.

The researchers declared a range of speakers fees, consultancies, and honoraria from the pharmaceutical industry; two of the authors were employees of Pfizer.

MELBOURNE – Widespread availability of automated external defibrillators is far more likely than screening to prevent sudden cardiac deaths on the sports field, and has the added benefit of also preventing deaths off the sports field, said Dr. N.A. Mark Estes, professor of medicine at Tufts University, Boston.

He said there were significant knowledge gaps around the sensitivity, specificity, and predictive accuracy of screening for sudden cardiac death in athletes, and existing screening guidelines were the subject of great criticism.

"Each one of these deaths is tragic, and everyone understandably reacts in a fashion where they want to do something to prevent it," Dr. Estes, also director of the cardiac arrhythmia center at Tufts, said at the World Congress of Cardiology.

Bianca Nogrady/Frontline Medical News

"The notion has arisen that in Italy they have an effective screening program that can identify athletes at risk of sudden cardiac death, so we should be able to do it in the United States."

There are, however, significant differences between Italy and the United States, which made it unlikely that the success of the Italian screening efforts could be replicated here, he said.

"The Italians have specialized centers that are regional, they have highly skilled physicians, they have a demographic that’s completely different with a very homogeneous population base and a condition called ARVC [arrhythmogenic right ventricular cardiomyopathy] that you can effectively screen for with ECG and echocardiography."

Guidelines from the American College of Cardiology/American Heart Association currently recommend a 2-4 yearly history and physical examination for young athletes but, unlike Italy, they do not include an ECG.

The other challenge with screening is that, despite the extensive media coverage given to athletes’ deaths on the field, the condition is very rare, claiming around 150 lives each year on the sports field and 4,000 deaths off of it.

Dr. Estes said screening might result in significant numbers of athletes being excluded from the sports field even though we don’t know if restricting athletes from sport does in fact have an impact.

Instead, he argued in favor of greater availability of automated external defibrillators (AEDs) in public places and particularly recreation sites, with evidence showing survival rates above 75% for sudden cardiac death in participating high schools and colleges.

"We need to recognize that the effectiveness of the AED on the athletic field is extremely high, and we do have a way of preventing sudden death even though we can’t predict it, and the benefits for society go well beyond the athletic field," Dr. Estes said in an interview.

"If you look at the evidence, it tells us that screening hasn’t worked in the United States; it is epidemiologically and statistically highly improbable that it would ever work; so let’s put our money into something that’s going to have some proven benefits in a cost-effective fashion."

Commenting on the presentation, Dr. David Prior of St. Vincent’s Hospital, Melbourne, said he was supportive of the idea of secondary rather than primary prevention of sudden cardiac arrest.

"There is certainly ongoing debate, and there are no really good randomized, controlled trials comparing screening to no screening, and I don’t think anyone is either brave enough or has pockets deep enough, because it would be a huge trial because the event rate is so low," Dr. Prior said at the meeting, which was sponsored by the World Heart Federation.

Dr. Prior said screening was a fairly blunt tool, whereas the data suggested that AEDs were effective.

Dr. Estes disclosed consultancies with Medtronic, Boston Scientific, and St. Jude Medical.

MELBOURNE – Widespread availability of automated external defibrillators is far more likely than screening to prevent sudden cardiac deaths on the sports field, and has the added benefit of also preventing deaths off the sports field, said Dr. N.A. Mark Estes, professor of medicine at Tufts University, Boston.

He said there were significant knowledge gaps around the sensitivity, specificity, and predictive accuracy of screening for sudden cardiac death in athletes, and existing screening guidelines were the subject of great criticism.

"Each one of these deaths is tragic, and everyone understandably reacts in a fashion where they want to do something to prevent it," Dr. Estes, also director of the cardiac arrhythmia center at Tufts, said at the World Congress of Cardiology.

Bianca Nogrady/Frontline Medical News

"The notion has arisen that in Italy they have an effective screening program that can identify athletes at risk of sudden cardiac death, so we should be able to do it in the United States."

There are, however, significant differences between Italy and the United States, which made it unlikely that the success of the Italian screening efforts could be replicated here, he said.

"The Italians have specialized centers that are regional, they have highly skilled physicians, they have a demographic that’s completely different with a very homogeneous population base and a condition called ARVC [arrhythmogenic right ventricular cardiomyopathy] that you can effectively screen for with ECG and echocardiography."

Guidelines from the American College of Cardiology/American Heart Association currently recommend a 2-4 yearly history and physical examination for young athletes but, unlike Italy, they do not include an ECG.

The other challenge with screening is that, despite the extensive media coverage given to athletes’ deaths on the field, the condition is very rare, claiming around 150 lives each year on the sports field and 4,000 deaths off of it.

Dr. Estes said screening might result in significant numbers of athletes being excluded from the sports field even though we don’t know if restricting athletes from sport does in fact have an impact.

Instead, he argued in favor of greater availability of automated external defibrillators (AEDs) in public places and particularly recreation sites, with evidence showing survival rates above 75% for sudden cardiac death in participating high schools and colleges.

"We need to recognize that the effectiveness of the AED on the athletic field is extremely high, and we do have a way of preventing sudden death even though we can’t predict it, and the benefits for society go well beyond the athletic field," Dr. Estes said in an interview.

"If you look at the evidence, it tells us that screening hasn’t worked in the United States; it is epidemiologically and statistically highly improbable that it would ever work; so let’s put our money into something that’s going to have some proven benefits in a cost-effective fashion."

Commenting on the presentation, Dr. David Prior of St. Vincent’s Hospital, Melbourne, said he was supportive of the idea of secondary rather than primary prevention of sudden cardiac arrest.

"There is certainly ongoing debate, and there are no really good randomized, controlled trials comparing screening to no screening, and I don’t think anyone is either brave enough or has pockets deep enough, because it would be a huge trial because the event rate is so low," Dr. Prior said at the meeting, which was sponsored by the World Heart Federation.

Dr. Prior said screening was a fairly blunt tool, whereas the data suggested that AEDs were effective.

Dr. Estes disclosed consultancies with Medtronic, Boston Scientific, and St. Jude Medical.

MELBOURNE – Widespread availability of automated external defibrillators is far more likely than screening to prevent sudden cardiac deaths on the sports field, and has the added benefit of also preventing deaths off the sports field, said Dr. N.A. Mark Estes, professor of medicine at Tufts University, Boston.

He said there were significant knowledge gaps around the sensitivity, specificity, and predictive accuracy of screening for sudden cardiac death in athletes, and existing screening guidelines were the subject of great criticism.

"Each one of these deaths is tragic, and everyone understandably reacts in a fashion where they want to do something to prevent it," Dr. Estes, also director of the cardiac arrhythmia center at Tufts, said at the World Congress of Cardiology.

Bianca Nogrady/Frontline Medical News

"The notion has arisen that in Italy they have an effective screening program that can identify athletes at risk of sudden cardiac death, so we should be able to do it in the United States."

There are, however, significant differences between Italy and the United States, which made it unlikely that the success of the Italian screening efforts could be replicated here, he said.

"The Italians have specialized centers that are regional, they have highly skilled physicians, they have a demographic that’s completely different with a very homogeneous population base and a condition called ARVC [arrhythmogenic right ventricular cardiomyopathy] that you can effectively screen for with ECG and echocardiography."

Guidelines from the American College of Cardiology/American Heart Association currently recommend a 2-4 yearly history and physical examination for young athletes but, unlike Italy, they do not include an ECG.

The other challenge with screening is that, despite the extensive media coverage given to athletes’ deaths on the field, the condition is very rare, claiming around 150 lives each year on the sports field and 4,000 deaths off of it.

Dr. Estes said screening might result in significant numbers of athletes being excluded from the sports field even though we don’t know if restricting athletes from sport does in fact have an impact.

Instead, he argued in favor of greater availability of automated external defibrillators (AEDs) in public places and particularly recreation sites, with evidence showing survival rates above 75% for sudden cardiac death in participating high schools and colleges.

"We need to recognize that the effectiveness of the AED on the athletic field is extremely high, and we do have a way of preventing sudden death even though we can’t predict it, and the benefits for society go well beyond the athletic field," Dr. Estes said in an interview.

"If you look at the evidence, it tells us that screening hasn’t worked in the United States; it is epidemiologically and statistically highly improbable that it would ever work; so let’s put our money into something that’s going to have some proven benefits in a cost-effective fashion."

Commenting on the presentation, Dr. David Prior of St. Vincent’s Hospital, Melbourne, said he was supportive of the idea of secondary rather than primary prevention of sudden cardiac arrest.

"There is certainly ongoing debate, and there are no really good randomized, controlled trials comparing screening to no screening, and I don’t think anyone is either brave enough or has pockets deep enough, because it would be a huge trial because the event rate is so low," Dr. Prior said at the meeting, which was sponsored by the World Heart Federation.

Dr. Prior said screening was a fairly blunt tool, whereas the data suggested that AEDs were effective.

Dr. Estes disclosed consultancies with Medtronic, Boston Scientific, and St. Jude Medical.

MELBOURNE – Women with heart disease are frequently underdiagnosed, undertreated, and underrepresented in clinical trials, and experience poorer outcomes both from inpatient and outpatient care.

Furthermore, while women have a tremendous amount of cardiovascular risk, they themselves are failing to recognize that heart disease is their No. 1 killer, Dr. Joanne M. Foody of Harvard Medical School, Boston, said at the World Congress of Cardiology 2014.

hepatus/iStockphoto.com

"The challenge is to ensure that women understand their risk, that the health care provider taking care of them understand their risk, and only by doing that can we really then impact their risk factors and treat them appropriately," said Dr. Foody, also director of the Pollin Cardiovascular Wellness Center at Brigham and Women’s Hospital, Boston.

Heart disease often presents differently in women than in men, with symptoms such as fatigue and breathlessness, which many women themselves would likely dismiss as just being part of a busy life.

While men tend to develop more focal plaques and narrowing of the arteries, women have smaller coronary arteries, even after body size is adjusted for, and therefore often have a more diffuse distribution of atherosclerosis.

"Women tend not to get that acute heart attack; they tend to have symptoms more related to small vessel disease which can lead to heart failure–like symptoms," she said.

Dr. Foody said that while the same cardiovascular risk factors apply to women and men, hormonal changes with menopause have a significant impact that is frequently underestimated by women and health care providers.

"Women undergo significant changes in their cholesterol levels, their blood pressure, and even their insulin resistance as they go through perimenopause and menopause, so it puts women at a unique transition point," Dr. Foody said. "Unfortunately, in women who were completely healthy and had no risk factors, that can change dramatically within the course of a couple of years."

Dr. Foody said that given the differences in presentation and treatment of heart disease in women, it is hardly surprising that women are more likely to die in the hospital, are more likely to experience reinfarction, and have a higher risk of heart failure, stroke, bleeding, and transfusion.

Women are also less likely to have an ECG performed within 10 minutes of hospital presentation, less likely to receive care from a cardiologist, and less likely to undergo diagnostic catheterization and revascularization procedures.

"These differences in care and in treatment can easily explain at least part of the disparities we see in outcomes for women," Dr. Foody said at the conference, which was sponsored by the World Heart Federation.

However, women themselves are also often more wary or skeptical of medication, Dr. Foody said, with evidence suggesting that married men are the most adherent to medication while married women are the least adherent.

Recent initiatives such as the global Go Red for Women and U.S.-based Screen Us campaigns were both aimed at raising awareness of heart disease among women and health care providers, but Dr. Foody said a system-level approach is required.

"That has to be coupled though with comparable programs that help inform health care providers, that help really put funding into appropriate screenings as well as appropriate research."

Dr. Foody said she had no relevant financial disclosures.

MELBOURNE – Women with heart disease are frequently underdiagnosed, undertreated, and underrepresented in clinical trials, and experience poorer outcomes both from inpatient and outpatient care.

Furthermore, while women have a tremendous amount of cardiovascular risk, they themselves are failing to recognize that heart disease is their No. 1 killer, Dr. Joanne M. Foody of Harvard Medical School, Boston, said at the World Congress of Cardiology 2014.

hepatus/iStockphoto.com

"The challenge is to ensure that women understand their risk, that the health care provider taking care of them understand their risk, and only by doing that can we really then impact their risk factors and treat them appropriately," said Dr. Foody, also director of the Pollin Cardiovascular Wellness Center at Brigham and Women’s Hospital, Boston.

Heart disease often presents differently in women than in men, with symptoms such as fatigue and breathlessness, which many women themselves would likely dismiss as just being part of a busy life.

While men tend to develop more focal plaques and narrowing of the arteries, women have smaller coronary arteries, even after body size is adjusted for, and therefore often have a more diffuse distribution of atherosclerosis.

"Women tend not to get that acute heart attack; they tend to have symptoms more related to small vessel disease which can lead to heart failure–like symptoms," she said.

Dr. Foody said that while the same cardiovascular risk factors apply to women and men, hormonal changes with menopause have a significant impact that is frequently underestimated by women and health care providers.

"Women undergo significant changes in their cholesterol levels, their blood pressure, and even their insulin resistance as they go through perimenopause and menopause, so it puts women at a unique transition point," Dr. Foody said. "Unfortunately, in women who were completely healthy and had no risk factors, that can change dramatically within the course of a couple of years."

Dr. Foody said that given the differences in presentation and treatment of heart disease in women, it is hardly surprising that women are more likely to die in the hospital, are more likely to experience reinfarction, and have a higher risk of heart failure, stroke, bleeding, and transfusion.

Women are also less likely to have an ECG performed within 10 minutes of hospital presentation, less likely to receive care from a cardiologist, and less likely to undergo diagnostic catheterization and revascularization procedures.

"These differences in care and in treatment can easily explain at least part of the disparities we see in outcomes for women," Dr. Foody said at the conference, which was sponsored by the World Heart Federation.

However, women themselves are also often more wary or skeptical of medication, Dr. Foody said, with evidence suggesting that married men are the most adherent to medication while married women are the least adherent.

Recent initiatives such as the global Go Red for Women and U.S.-based Screen Us campaigns were both aimed at raising awareness of heart disease among women and health care providers, but Dr. Foody said a system-level approach is required.

"That has to be coupled though with comparable programs that help inform health care providers, that help really put funding into appropriate screenings as well as appropriate research."

Dr. Foody said she had no relevant financial disclosures.

MELBOURNE – Women with heart disease are frequently underdiagnosed, undertreated, and underrepresented in clinical trials, and experience poorer outcomes both from inpatient and outpatient care.

Furthermore, while women have a tremendous amount of cardiovascular risk, they themselves are failing to recognize that heart disease is their No. 1 killer, Dr. Joanne M. Foody of Harvard Medical School, Boston, said at the World Congress of Cardiology 2014.

hepatus/iStockphoto.com

"The challenge is to ensure that women understand their risk, that the health care provider taking care of them understand their risk, and only by doing that can we really then impact their risk factors and treat them appropriately," said Dr. Foody, also director of the Pollin Cardiovascular Wellness Center at Brigham and Women’s Hospital, Boston.

Heart disease often presents differently in women than in men, with symptoms such as fatigue and breathlessness, which many women themselves would likely dismiss as just being part of a busy life.

While men tend to develop more focal plaques and narrowing of the arteries, women have smaller coronary arteries, even after body size is adjusted for, and therefore often have a more diffuse distribution of atherosclerosis.

"Women tend not to get that acute heart attack; they tend to have symptoms more related to small vessel disease which can lead to heart failure–like symptoms," she said.

Dr. Foody said that while the same cardiovascular risk factors apply to women and men, hormonal changes with menopause have a significant impact that is frequently underestimated by women and health care providers.

"Women undergo significant changes in their cholesterol levels, their blood pressure, and even their insulin resistance as they go through perimenopause and menopause, so it puts women at a unique transition point," Dr. Foody said. "Unfortunately, in women who were completely healthy and had no risk factors, that can change dramatically within the course of a couple of years."

Dr. Foody said that given the differences in presentation and treatment of heart disease in women, it is hardly surprising that women are more likely to die in the hospital, are more likely to experience reinfarction, and have a higher risk of heart failure, stroke, bleeding, and transfusion.

Women are also less likely to have an ECG performed within 10 minutes of hospital presentation, less likely to receive care from a cardiologist, and less likely to undergo diagnostic catheterization and revascularization procedures.

"These differences in care and in treatment can easily explain at least part of the disparities we see in outcomes for women," Dr. Foody said at the conference, which was sponsored by the World Heart Federation.

However, women themselves are also often more wary or skeptical of medication, Dr. Foody said, with evidence suggesting that married men are the most adherent to medication while married women are the least adherent.

Recent initiatives such as the global Go Red for Women and U.S.-based Screen Us campaigns were both aimed at raising awareness of heart disease among women and health care providers, but Dr. Foody said a system-level approach is required.

"That has to be coupled though with comparable programs that help inform health care providers, that help really put funding into appropriate screenings as well as appropriate research."

Dr. Foody said she had no relevant financial disclosures.

MELBOURNE – Specialist cardio-oncology clinics may be needed to address the long-term cardiac care of cancer patients treated with cardiotoxic chemotherapy regimens such as anthracyclines and trastuzumab, presenters told the World Congress of Cardiology 2014.

Dr. Puja K. Mehta, codirector of the cardio-oncology program at the Barbra Streisand Women’s Heart Center, presented poster data showing that 12% of women who attended the clinic over a 7-month period had a previous diagnosis of cancer, nearly half of which were cases of breast cancer.

The study of 892 patients seen at the center found that 92% of all breast cancer survivors had at least one cardiac risk factor – 55% had hypertension, 64% had hyperlipidemia, 14% had diabetes, 18% coronary artery disease, and 23% ischemic heart disease.

There is growing awareness of the long-term sequelae of cardiotoxic chemotherapy regimens but the challenge was how to take a preventive approach to the problem, Dr. Mehta said at the meeting sponsored by the World Heart Federation.

"People who have had a history of breast cancer ... often they’re only seeing oncologists to follow up on breast cancer recurrence so they are getting yearly mammograms and those things, but what they’ve missed is a little bit of hypertension that’s been there for years and then you get the accelerated atherosclerosis," Dr. Mehta said in an interview with Cardiology News.

The study’s authors suggest that cardio-oncology clinics could play an important role in implementing lifestyle modification and preventive interventions to reduce the risk of cardiac sequelae in cancer survivors.

In another presentation, American Heart Association President Mariell Jessup, Medical Director of the Penn Heart and Vascular Center, said early-onset cardiotoxicity occurs in a relatively small percent of patients – around 1%-2% – within the first year after chemotherapy treatment.

However late-onset cardiotoxicity was far more insidious as it affected a wide range of patients and the signs may not manifest until long after chemotherapy.

"We used to be taught that it came within the first year or so, and so when someone showed up 10 years or 15 years from treatment we discounted the fact that it was cardiotoxicity from anthracycline," Dr. Jessup told Cardiology News.

Dr. Jessup said an estimated 20%-30% of patients who had been treated with anthracyclines would likely show some kind of cardiac problems, but the addition of trastuzumab to breast cancer chemotherapy further increased the risk.

"They can present with heart failure ... but if they have radiotherapy on top of chemotherapy they are more susceptible to proximal coronary disease," she said.

"Then we’re seeing a group of patients that end up at cardiac transplant because of their heart failure, and they have very fragile bone marrows so they don’t tolerate immunosuppression as well, and they tend to be very anemic."

Dr. Jessup told the conference that more research was critical to understand the mechanisms of anthracycline cardiotoxicity, and to identify predictive markers of cardiac damage, but she stressed clinician awareness was also fundamental.

"We need to educate clinicians about not only the importance of these chemotherapeutic agents to the survival of patients following their cancer but how to be particularly attuned to the possibility that exposure many years before can lead to cardiac toxicity."

A member of the audience raised the question about treating patients with angiotensin-converting enzyme inhibitors at the same time as their chemotherapy to reduce the cardiac impact of the chemotherapy.

Dr. Jessup said while there were some intriguing data emerging about the concurrent use of ACE inhibitors and beta-blockers in patients treated with anthracyclines, there still remained questions about when the drugs should be used as they may not be well tolerated during chemotherapy.

Dr. Jessup had no disclosures. Dr. Mehta declared grant/research support from Gilead, and a coauthor declared grant/research support from Gilead and consultancies and honoraria from a range of organizations.

MELBOURNE – Specialist cardio-oncology clinics may be needed to address the long-term cardiac care of cancer patients treated with cardiotoxic chemotherapy regimens such as anthracyclines and trastuzumab, presenters told the World Congress of Cardiology 2014.

Dr. Puja K. Mehta, codirector of the cardio-oncology program at the Barbra Streisand Women’s Heart Center, presented poster data showing that 12% of women who attended the clinic over a 7-month period had a previous diagnosis of cancer, nearly half of which were cases of breast cancer.

The study of 892 patients seen at the center found that 92% of all breast cancer survivors had at least one cardiac risk factor – 55% had hypertension, 64% had hyperlipidemia, 14% had diabetes, 18% coronary artery disease, and 23% ischemic heart disease.

There is growing awareness of the long-term sequelae of cardiotoxic chemotherapy regimens but the challenge was how to take a preventive approach to the problem, Dr. Mehta said at the meeting sponsored by the World Heart Federation.

"People who have had a history of breast cancer ... often they’re only seeing oncologists to follow up on breast cancer recurrence so they are getting yearly mammograms and those things, but what they’ve missed is a little bit of hypertension that’s been there for years and then you get the accelerated atherosclerosis," Dr. Mehta said in an interview with Cardiology News.

The study’s authors suggest that cardio-oncology clinics could play an important role in implementing lifestyle modification and preventive interventions to reduce the risk of cardiac sequelae in cancer survivors.

In another presentation, American Heart Association President Mariell Jessup, Medical Director of the Penn Heart and Vascular Center, said early-onset cardiotoxicity occurs in a relatively small percent of patients – around 1%-2% – within the first year after chemotherapy treatment.

However late-onset cardiotoxicity was far more insidious as it affected a wide range of patients and the signs may not manifest until long after chemotherapy.

"We used to be taught that it came within the first year or so, and so when someone showed up 10 years or 15 years from treatment we discounted the fact that it was cardiotoxicity from anthracycline," Dr. Jessup told Cardiology News.

Dr. Jessup said an estimated 20%-30% of patients who had been treated with anthracyclines would likely show some kind of cardiac problems, but the addition of trastuzumab to breast cancer chemotherapy further increased the risk.

"They can present with heart failure ... but if they have radiotherapy on top of chemotherapy they are more susceptible to proximal coronary disease," she said.

"Then we’re seeing a group of patients that end up at cardiac transplant because of their heart failure, and they have very fragile bone marrows so they don’t tolerate immunosuppression as well, and they tend to be very anemic."

Dr. Jessup told the conference that more research was critical to understand the mechanisms of anthracycline cardiotoxicity, and to identify predictive markers of cardiac damage, but she stressed clinician awareness was also fundamental.

"We need to educate clinicians about not only the importance of these chemotherapeutic agents to the survival of patients following their cancer but how to be particularly attuned to the possibility that exposure many years before can lead to cardiac toxicity."

A member of the audience raised the question about treating patients with angiotensin-converting enzyme inhibitors at the same time as their chemotherapy to reduce the cardiac impact of the chemotherapy.

Dr. Jessup said while there were some intriguing data emerging about the concurrent use of ACE inhibitors and beta-blockers in patients treated with anthracyclines, there still remained questions about when the drugs should be used as they may not be well tolerated during chemotherapy.

Dr. Jessup had no disclosures. Dr. Mehta declared grant/research support from Gilead, and a coauthor declared grant/research support from Gilead and consultancies and honoraria from a range of organizations.

MELBOURNE – Specialist cardio-oncology clinics may be needed to address the long-term cardiac care of cancer patients treated with cardiotoxic chemotherapy regimens such as anthracyclines and trastuzumab, presenters told the World Congress of Cardiology 2014.

Dr. Puja K. Mehta, codirector of the cardio-oncology program at the Barbra Streisand Women’s Heart Center, presented poster data showing that 12% of women who attended the clinic over a 7-month period had a previous diagnosis of cancer, nearly half of which were cases of breast cancer.

The study of 892 patients seen at the center found that 92% of all breast cancer survivors had at least one cardiac risk factor – 55% had hypertension, 64% had hyperlipidemia, 14% had diabetes, 18% coronary artery disease, and 23% ischemic heart disease.

There is growing awareness of the long-term sequelae of cardiotoxic chemotherapy regimens but the challenge was how to take a preventive approach to the problem, Dr. Mehta said at the meeting sponsored by the World Heart Federation.

"People who have had a history of breast cancer ... often they’re only seeing oncologists to follow up on breast cancer recurrence so they are getting yearly mammograms and those things, but what they’ve missed is a little bit of hypertension that’s been there for years and then you get the accelerated atherosclerosis," Dr. Mehta said in an interview with Cardiology News.

The study’s authors suggest that cardio-oncology clinics could play an important role in implementing lifestyle modification and preventive interventions to reduce the risk of cardiac sequelae in cancer survivors.

In another presentation, American Heart Association President Mariell Jessup, Medical Director of the Penn Heart and Vascular Center, said early-onset cardiotoxicity occurs in a relatively small percent of patients – around 1%-2% – within the first year after chemotherapy treatment.

However late-onset cardiotoxicity was far more insidious as it affected a wide range of patients and the signs may not manifest until long after chemotherapy.

"We used to be taught that it came within the first year or so, and so when someone showed up 10 years or 15 years from treatment we discounted the fact that it was cardiotoxicity from anthracycline," Dr. Jessup told Cardiology News.

Dr. Jessup said an estimated 20%-30% of patients who had been treated with anthracyclines would likely show some kind of cardiac problems, but the addition of trastuzumab to breast cancer chemotherapy further increased the risk.

"They can present with heart failure ... but if they have radiotherapy on top of chemotherapy they are more susceptible to proximal coronary disease," she said.

"Then we’re seeing a group of patients that end up at cardiac transplant because of their heart failure, and they have very fragile bone marrows so they don’t tolerate immunosuppression as well, and they tend to be very anemic."

Dr. Jessup told the conference that more research was critical to understand the mechanisms of anthracycline cardiotoxicity, and to identify predictive markers of cardiac damage, but she stressed clinician awareness was also fundamental.

"We need to educate clinicians about not only the importance of these chemotherapeutic agents to the survival of patients following their cancer but how to be particularly attuned to the possibility that exposure many years before can lead to cardiac toxicity."

A member of the audience raised the question about treating patients with angiotensin-converting enzyme inhibitors at the same time as their chemotherapy to reduce the cardiac impact of the chemotherapy.

Dr. Jessup said while there were some intriguing data emerging about the concurrent use of ACE inhibitors and beta-blockers in patients treated with anthracyclines, there still remained questions about when the drugs should be used as they may not be well tolerated during chemotherapy.

Dr. Jessup had no disclosures. Dr. Mehta declared grant/research support from Gilead, and a coauthor declared grant/research support from Gilead and consultancies and honoraria from a range of organizations.

MELBOURNE – A polypill combining aspirin, simvastatin, and two antihypertensive drugs has shown a significant improvement in adherence as well as reductions in blood pressure and LDL cholesterol in patients with existing heart disease, according to data from a large international multicenter trial.

The Single Pill to Avert Cardiovascular Events (SPACE) project – a randomized, open-label, controlled trial in 3,140 patients – showed a 43% increase in patient adherence to their medication at 12 months.

Data presented at the World Congress of Cardiology 2014 showed the polypill also led to a statistically significant 2.8–mm Hg drop in systolic blood pressure and 0.1 mmol/L decline in LDL cholesterol.

Presenter and epidemiologist Dr. Ruth Webster said adherence was one of three primary outcomes of the analysis, which included data from three separately run but coordinated trials in Australia, New Zealand, Europe, and India.

Courtesy Bianca Nogrady

"In high-income countries, about 50% of people who should be taking their medications take them, and in lower-middle income countries, 90% of people don’t take their medications," said Dr. Webster, international coordinator for the SPACE collaboration and research fellow at The George Institute for Global Health.

"An estimated 100 million people worldwide should be taking these drugs but aren’t, so in that context even small improvements in blood pressure and LDL cholesterol will have a massive impact globally," Dr. Webster said at the meeting sponsored by the World Heart Federation.

Dr. Webster also pointed out that while the blood pressure and LDL cholesterol gains were modest, they were achieved against a control population receiving the usual care, not an untreated population.

The polypill was consistently associated with improvements in adherence across the different study populations, although subgroup analysis revealed a fourfold increase in adherence at 12 months among patients who weren’t taking their prescribed medications at baseline.

"If you’re struggling to take all your medications or you don’t have access to them ... then this could be a huge help in bridging that evidence-practice gap," Dr. Webster told the conference attendees.

The SPACE project trials enrolled individuals with pre-existing cardiovascular disease or who were at high risk (at least 15% over 5 years) but had not had a primary event. Around two-thirds of patients in both arms had a history of coronary heart disease, approximately 14% had a history of cerebrovascular disease, and just over one-third had diabetes.

The polypill, which was prescribed in the primary care setting, contained 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and either 50 mg atenolol or 12.5 mg hydrochlorothiazide.

Commenting on the study, Dr. Sidney C. Smith Jr. said it was not unusual to see patients come into hospital with as many as twelve different medications.

"In coronary artery disease, we know that the use of three to four key medications – aspirin, statins, ACE inhibitors and beta-blockers – may reduce future events by as much as 70% ... and yet study after study using current pills and therapy is showing that a minority of patients are taking all four medications," said Dr. Smith.

"That has led to the idea that if we could combine all these medications into one tablet, it just might have a huge impact," Dr. Smith said.

While polypills are not yet available on the market in the United States and other major markets, Dr. Webster said it was anticipated that some might become available within a couple of years.

The SPACE collaboration studies are all publicly funded, and the coordinating centre was partly funded by an unrestricted education grant from Dr. Reddy’s Laboratories (Hyderabad, India), which also supplied the polypill (Red Heart Pill) used in the study. The George Institute has since negotiated an exclusive global license for the rights to the polypill used in the study.

MELBOURNE – A polypill combining aspirin, simvastatin, and two antihypertensive drugs has shown a significant improvement in adherence as well as reductions in blood pressure and LDL cholesterol in patients with existing heart disease, according to data from a large international multicenter trial.

The Single Pill to Avert Cardiovascular Events (SPACE) project – a randomized, open-label, controlled trial in 3,140 patients – showed a 43% increase in patient adherence to their medication at 12 months.

Data presented at the World Congress of Cardiology 2014 showed the polypill also led to a statistically significant 2.8–mm Hg drop in systolic blood pressure and 0.1 mmol/L decline in LDL cholesterol.

Presenter and epidemiologist Dr. Ruth Webster said adherence was one of three primary outcomes of the analysis, which included data from three separately run but coordinated trials in Australia, New Zealand, Europe, and India.

Courtesy Bianca Nogrady

"In high-income countries, about 50% of people who should be taking their medications take them, and in lower-middle income countries, 90% of people don’t take their medications," said Dr. Webster, international coordinator for the SPACE collaboration and research fellow at The George Institute for Global Health.

"An estimated 100 million people worldwide should be taking these drugs but aren’t, so in that context even small improvements in blood pressure and LDL cholesterol will have a massive impact globally," Dr. Webster said at the meeting sponsored by the World Heart Federation.

Dr. Webster also pointed out that while the blood pressure and LDL cholesterol gains were modest, they were achieved against a control population receiving the usual care, not an untreated population.

The polypill was consistently associated with improvements in adherence across the different study populations, although subgroup analysis revealed a fourfold increase in adherence at 12 months among patients who weren’t taking their prescribed medications at baseline.

"If you’re struggling to take all your medications or you don’t have access to them ... then this could be a huge help in bridging that evidence-practice gap," Dr. Webster told the conference attendees.

The SPACE project trials enrolled individuals with pre-existing cardiovascular disease or who were at high risk (at least 15% over 5 years) but had not had a primary event. Around two-thirds of patients in both arms had a history of coronary heart disease, approximately 14% had a history of cerebrovascular disease, and just over one-third had diabetes.

The polypill, which was prescribed in the primary care setting, contained 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and either 50 mg atenolol or 12.5 mg hydrochlorothiazide.

Commenting on the study, Dr. Sidney C. Smith Jr. said it was not unusual to see patients come into hospital with as many as twelve different medications.

"In coronary artery disease, we know that the use of three to four key medications – aspirin, statins, ACE inhibitors and beta-blockers – may reduce future events by as much as 70% ... and yet study after study using current pills and therapy is showing that a minority of patients are taking all four medications," said Dr. Smith.

"That has led to the idea that if we could combine all these medications into one tablet, it just might have a huge impact," Dr. Smith said.

While polypills are not yet available on the market in the United States and other major markets, Dr. Webster said it was anticipated that some might become available within a couple of years.

The SPACE collaboration studies are all publicly funded, and the coordinating centre was partly funded by an unrestricted education grant from Dr. Reddy’s Laboratories (Hyderabad, India), which also supplied the polypill (Red Heart Pill) used in the study. The George Institute has since negotiated an exclusive global license for the rights to the polypill used in the study.

MELBOURNE – A polypill combining aspirin, simvastatin, and two antihypertensive drugs has shown a significant improvement in adherence as well as reductions in blood pressure and LDL cholesterol in patients with existing heart disease, according to data from a large international multicenter trial.

The Single Pill to Avert Cardiovascular Events (SPACE) project – a randomized, open-label, controlled trial in 3,140 patients – showed a 43% increase in patient adherence to their medication at 12 months.

Data presented at the World Congress of Cardiology 2014 showed the polypill also led to a statistically significant 2.8–mm Hg drop in systolic blood pressure and 0.1 mmol/L decline in LDL cholesterol.

Presenter and epidemiologist Dr. Ruth Webster said adherence was one of three primary outcomes of the analysis, which included data from three separately run but coordinated trials in Australia, New Zealand, Europe, and India.

Courtesy Bianca Nogrady

"In high-income countries, about 50% of people who should be taking their medications take them, and in lower-middle income countries, 90% of people don’t take their medications," said Dr. Webster, international coordinator for the SPACE collaboration and research fellow at The George Institute for Global Health.

"An estimated 100 million people worldwide should be taking these drugs but aren’t, so in that context even small improvements in blood pressure and LDL cholesterol will have a massive impact globally," Dr. Webster said at the meeting sponsored by the World Heart Federation.

Dr. Webster also pointed out that while the blood pressure and LDL cholesterol gains were modest, they were achieved against a control population receiving the usual care, not an untreated population.

The polypill was consistently associated with improvements in adherence across the different study populations, although subgroup analysis revealed a fourfold increase in adherence at 12 months among patients who weren’t taking their prescribed medications at baseline.

"If you’re struggling to take all your medications or you don’t have access to them ... then this could be a huge help in bridging that evidence-practice gap," Dr. Webster told the conference attendees.

The SPACE project trials enrolled individuals with pre-existing cardiovascular disease or who were at high risk (at least 15% over 5 years) but had not had a primary event. Around two-thirds of patients in both arms had a history of coronary heart disease, approximately 14% had a history of cerebrovascular disease, and just over one-third had diabetes.

The polypill, which was prescribed in the primary care setting, contained 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and either 50 mg atenolol or 12.5 mg hydrochlorothiazide.

Commenting on the study, Dr. Sidney C. Smith Jr. said it was not unusual to see patients come into hospital with as many as twelve different medications.

"In coronary artery disease, we know that the use of three to four key medications – aspirin, statins, ACE inhibitors and beta-blockers – may reduce future events by as much as 70% ... and yet study after study using current pills and therapy is showing that a minority of patients are taking all four medications," said Dr. Smith.

"That has led to the idea that if we could combine all these medications into one tablet, it just might have a huge impact," Dr. Smith said.

While polypills are not yet available on the market in the United States and other major markets, Dr. Webster said it was anticipated that some might become available within a couple of years.

The SPACE collaboration studies are all publicly funded, and the coordinating centre was partly funded by an unrestricted education grant from Dr. Reddy’s Laboratories (Hyderabad, India), which also supplied the polypill (Red Heart Pill) used in the study. The George Institute has since negotiated an exclusive global license for the rights to the polypill used in the study.

MELBOURNE – A polypill combining aspirin, simvastatin, and two antihypertensive drugs has shown a significant improvement in adherence as well as reductions in blood pressure and LDL cholesterol in patients with existing heart disease, according to data from a large international multicenter trial.

The Single Pill to Avert Cardiovascular Events (SPACE) project – a randomized, open-label, controlled trial in 3,140 patients – showed a 43% increase in patient adherence to their medication at 12 months.

Data presented at the World Congress of Cardiology 2014 showed the polypill also led to a statistically significant 2.8–mm Hg drop in systolic blood pressure and 0.1 mmol/L decline in LDL cholesterol.

Presenter and epidemiologist Dr. Ruth Webster said adherence was one of three primary outcomes of the analysis, which included data from three separately run but coordinated trials in Australia, New Zealand, Europe, and India.

Courtesy Bianca Nogrady

"In high-income countries, about 50% of people who should be taking their medications take them, and in lower-middle income countries, 90% of people don’t take their medications," said Dr. Webster, international coordinator for the SPACE collaboration and research fellow at The George Institute for Global Health.

"An estimated 100 million people worldwide should be taking these drugs but aren’t, so in that context even small improvements in blood pressure and LDL cholesterol will have a massive impact globally," Dr. Webster said at the meeting sponsored by the World Heart Federation.

Dr. Webster also pointed out that while the blood pressure and LDL cholesterol gains were modest, they were achieved against a control population receiving the usual care, not an untreated population.

The polypill was consistently associated with improvements in adherence across the different study populations, although subgroup analysis revealed a fourfold increase in adherence at 12 months among patients who weren’t taking their prescribed medications at baseline.

"If you’re struggling to take all your medications or you don’t have access to them ... then this could be a huge help in bridging that evidence-practice gap," Dr. Webster told the conference attendees.

The SPACE project trials enrolled individuals with pre-existing cardiovascular disease or who were at high risk (at least 15% over 5 years) but had not had a primary event. Around two-thirds of patients in both arms had a history of coronary heart disease, approximately 14% had a history of cerebrovascular disease, and just over one-third had diabetes.

The polypill, which was prescribed in the primary care setting, contained 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and either 50 mg atenolol or 12.5 mg hydrochlorothiazide.

Commenting on the study, Dr. Sidney C. Smith Jr. said it was not unusual to see patients come into hospital with as many as twelve different medications.

"In coronary artery disease, we know that the use of three to four key medications – aspirin, statins, ACE inhibitors and beta-blockers – may reduce future events by as much as 70% ... and yet study after study using current pills and therapy is showing that a minority of patients are taking all four medications," said Dr. Smith.

"That has led to the idea that if we could combine all these medications into one tablet, it just might have a huge impact," Dr. Smith said.

While polypills are not yet available on the market in the United States and other major markets, Dr. Webster said it was anticipated that some might become available within a couple of years.

The SPACE collaboration studies are all publicly funded, and the coordinating centre was partly funded by an unrestricted education grant from Dr. Reddy’s Laboratories (Hyderabad, India), which also supplied the polypill (Red Heart Pill) used in the study. The George Institute has since negotiated an exclusive global license for the rights to the polypill used in the study.

MELBOURNE – A polypill combining aspirin, simvastatin, and two antihypertensive drugs has shown a significant improvement in adherence as well as reductions in blood pressure and LDL cholesterol in patients with existing heart disease, according to data from a large international multicenter trial.

The Single Pill to Avert Cardiovascular Events (SPACE) project – a randomized, open-label, controlled trial in 3,140 patients – showed a 43% increase in patient adherence to their medication at 12 months.

Data presented at the World Congress of Cardiology 2014 showed the polypill also led to a statistically significant 2.8–mm Hg drop in systolic blood pressure and 0.1 mmol/L decline in LDL cholesterol.

Presenter and epidemiologist Dr. Ruth Webster said adherence was one of three primary outcomes of the analysis, which included data from three separately run but coordinated trials in Australia, New Zealand, Europe, and India.

Courtesy Bianca Nogrady

"In high-income countries, about 50% of people who should be taking their medications take them, and in lower-middle income countries, 90% of people don’t take their medications," said Dr. Webster, international coordinator for the SPACE collaboration and research fellow at The George Institute for Global Health.

"An estimated 100 million people worldwide should be taking these drugs but aren’t, so in that context even small improvements in blood pressure and LDL cholesterol will have a massive impact globally," Dr. Webster said at the meeting sponsored by the World Heart Federation.

Dr. Webster also pointed out that while the blood pressure and LDL cholesterol gains were modest, they were achieved against a control population receiving the usual care, not an untreated population.

The polypill was consistently associated with improvements in adherence across the different study populations, although subgroup analysis revealed a fourfold increase in adherence at 12 months among patients who weren’t taking their prescribed medications at baseline.

"If you’re struggling to take all your medications or you don’t have access to them ... then this could be a huge help in bridging that evidence-practice gap," Dr. Webster told the conference attendees.

The SPACE project trials enrolled individuals with pre-existing cardiovascular disease or who were at high risk (at least 15% over 5 years) but had not had a primary event. Around two-thirds of patients in both arms had a history of coronary heart disease, approximately 14% had a history of cerebrovascular disease, and just over one-third had diabetes.

The polypill, which was prescribed in the primary care setting, contained 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and either 50 mg atenolol or 12.5 mg hydrochlorothiazide.

Commenting on the study, Dr. Sidney C. Smith Jr. said it was not unusual to see patients come into hospital with as many as twelve different medications.

"In coronary artery disease, we know that the use of three to four key medications – aspirin, statins, ACE inhibitors and beta-blockers – may reduce future events by as much as 70% ... and yet study after study using current pills and therapy is showing that a minority of patients are taking all four medications," said Dr. Smith.

"That has led to the idea that if we could combine all these medications into one tablet, it just might have a huge impact," Dr. Smith said.

While polypills are not yet available on the market in the United States and other major markets, Dr. Webster said it was anticipated that some might become available within a couple of years.

The SPACE collaboration studies are all publicly funded, and the coordinating centre was partly funded by an unrestricted education grant from Dr. Reddy’s Laboratories (Hyderabad, India), which also supplied the polypill (Red Heart Pill) used in the study. The George Institute has since negotiated an exclusive global license for the rights to the polypill used in the study.

MELBOURNE – A polypill combining aspirin, simvastatin, and two antihypertensive drugs has shown a significant improvement in adherence as well as reductions in blood pressure and LDL cholesterol in patients with existing heart disease, according to data from a large international multicenter trial.

The Single Pill to Avert Cardiovascular Events (SPACE) project – a randomized, open-label, controlled trial in 3,140 patients – showed a 43% increase in patient adherence to their medication at 12 months.

Data presented at the World Congress of Cardiology 2014 showed the polypill also led to a statistically significant 2.8–mm Hg drop in systolic blood pressure and 0.1 mmol/L decline in LDL cholesterol.

Presenter and epidemiologist Dr. Ruth Webster said adherence was one of three primary outcomes of the analysis, which included data from three separately run but coordinated trials in Australia, New Zealand, Europe, and India.

Courtesy Bianca Nogrady

"In high-income countries, about 50% of people who should be taking their medications take them, and in lower-middle income countries, 90% of people don’t take their medications," said Dr. Webster, international coordinator for the SPACE collaboration and research fellow at The George Institute for Global Health.

"An estimated 100 million people worldwide should be taking these drugs but aren’t, so in that context even small improvements in blood pressure and LDL cholesterol will have a massive impact globally," Dr. Webster said at the meeting sponsored by the World Heart Federation.

Dr. Webster also pointed out that while the blood pressure and LDL cholesterol gains were modest, they were achieved against a control population receiving the usual care, not an untreated population.

The polypill was consistently associated with improvements in adherence across the different study populations, although subgroup analysis revealed a fourfold increase in adherence at 12 months among patients who weren’t taking their prescribed medications at baseline.

"If you’re struggling to take all your medications or you don’t have access to them ... then this could be a huge help in bridging that evidence-practice gap," Dr. Webster told the conference attendees.

The SPACE project trials enrolled individuals with pre-existing cardiovascular disease or who were at high risk (at least 15% over 5 years) but had not had a primary event. Around two-thirds of patients in both arms had a history of coronary heart disease, approximately 14% had a history of cerebrovascular disease, and just over one-third had diabetes.

The polypill, which was prescribed in the primary care setting, contained 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and either 50 mg atenolol or 12.5 mg hydrochlorothiazide.

Commenting on the study, Dr. Sidney C. Smith Jr. said it was not unusual to see patients come into hospital with as many as twelve different medications.

"In coronary artery disease, we know that the use of three to four key medications – aspirin, statins, ACE inhibitors and beta-blockers – may reduce future events by as much as 70% ... and yet study after study using current pills and therapy is showing that a minority of patients are taking all four medications," said Dr. Smith.

"That has led to the idea that if we could combine all these medications into one tablet, it just might have a huge impact," Dr. Smith said.

While polypills are not yet available on the market in the United States and other major markets, Dr. Webster said it was anticipated that some might become available within a couple of years.

The SPACE collaboration studies are all publicly funded, and the coordinating centre was partly funded by an unrestricted education grant from Dr. Reddy’s Laboratories (Hyderabad, India), which also supplied the polypill (Red Heart Pill) used in the study. The George Institute has since negotiated an exclusive global license for the rights to the polypill used in the study.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

© Georges Lievre/Fotolia.com

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

© Georges Lievre/Fotolia.com

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

© Georges Lievre/Fotolia.com

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

© Georges Lievre/Fotolia.com

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

© Georges Lievre/Fotolia.com

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

© Georges Lievre/Fotolia.com

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.